STATEN ISLAND MEDICAL PRACTICE P.C. NPI 1104142082

NPI Information

NPI: 1104142082
Provider Name: STATEN ISLAND MEDICAL PRACTICE, P.C.
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
Address: 5405 HYLAN BLVD
STATEN ISLAND, NY
ZIP 10312
Phone: (718) 948-5475

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NPI Details

STATEN ISLAND MEDICAL PRACTICE, P.C. is a primary care clinic center in Staten Island, NY. STATEN ISLAND MEDICAL PRACTICE, P.C. NPI is 1104142082. The provider is registered as an organization entity type.

The provider's business location address is:

5405 HYLAN BLVD
STATEN ISLAND, NY
ZIP 10312-241
Phone: (718) 948-5475
Fax: (718) 948-5479

The provider's authorized official is Leonard J Marchetta .
The authorized official title is Physicians' Assistant and has the following contact phone number (718) 948-5475.

The enumeration date for this NPI number is 4/16/2010 and was last updated on 4/16/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	191751	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11177655	OTHER		CAQH
2	01860833	MEDICAID	NEW YORK
3	72411	MEDICARE PIN
4	G59515	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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